113 lines
3.9 KiB
YAML
113 lines
3.9 KiB
YAML
abstract: 'BackgroundThe continuing impetus for universal health coverage has given
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rise to publicly funded health insurance schemes in lower-middle income
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countries. However, there is insufficient understanding of how universal
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health coverage schemes impact gender equality and equity. This paper
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attempts to understand why utilization of a publicly funded health
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insurance scheme has been found to be lower among women compared to men
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in a southern Indian state. It aims to identify the gender barriers
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across various social institutions that thwart the policy objectives of
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providing financial protection and improved access to inpatient care for
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women.MethodsA qualitative study on the Chief Minister''s Comprehensive
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Health Insurance Scheme was carried out in urban and rural impoverished
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localities in Tamil Nadu, a southern state in India. Thirty-three women
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and 16 men who had a recent history of hospitalization and 14
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stakeholders were purposefully interviewed. Transcribed interviews were
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content analyzed based on Naila Kabeer''s Social Relations Framework
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using gender as an analytical category.ResultsWhile unpacking the
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navigation pathways of women to utilize publicly funded health insurance
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to access inpatient care, gender barriers are found operating at the
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household, community, and programmatic levels. Unpaid care work,
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financial dependence, mobility constraints, and gender norms emerged as
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the major gender-specific barriers arising from the household.
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Exclusions from insurance enrollment activities at the community level
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were mediated by a variety of social inequities. Market ideologies in
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insurance and health, combined with poor governance by State, resulted
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in out-of-pocket health expenditures, acute information asymmetry,
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selective availability of care, and poor acceptability. These gender
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barriers were found to be mediated by all four institutions-household,
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community, market, and State-resulting in lower utilization of the
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scheme by women.ConclusionsHealth policies which aim to provide
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financial protection and improve access to healthcare services need to
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address gender as a crucial social determinant. A gender-blind health
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insurance can not only leave many pre-existing gender barriers
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unaddressed but also accentuate others. This paper stresses that
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universal health coverage policy and programs need to have an explicit
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focus on gender and other social determinants to promote access and
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equity.'
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affiliation: 'RamPrakash, R (Corresponding Author), Loyola Coll Campus, Loyola Inst
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Business Adm, Chennai 600034, Tamil Nadu, India.
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RamPrakash, Rajalakshmi, Loyola Coll Campus, Loyola Inst Business Adm, Chennai 600034,
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Tamil Nadu, India.
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Lingam, Lakshmi, Inst Social Sci, VN Purav Marg, Mumbai 400088, Maharashtra, India.'
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article-number: '350'
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author: RamPrakash, Rajalakshmi and Lingam, Lakshmi
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author-email: rajalaksh@gmail.com
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author_list:
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- family: RamPrakash
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given: Rajalakshmi
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- family: Lingam
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given: Lakshmi
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da: '2023-09-28'
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doi: 10.1186/s12889-021-10352-4
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eissn: 1471-2458
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files: []
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journal: BMC PUBLIC HEALTH
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keywords: 'Gender; Publicly funded health insurance (PFHI); Universal health
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coverage (UHC); Social relations (SR) framework; India; Gender analysis'
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keywords-plus: EQUITY; CARE; INTERVIEWS; RESOURCE; GENDER; POLICY
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language: English
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month: FEB 12
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number: '1'
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number-of-cited-references: '61'
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orcid-numbers: RamPrakash, Rajalakshmi/0000-0001-6785-5239
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papis_id: 498cbe7b2661f28b04b0e121cbc752ee
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ref: Ramprakash2021whyis
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times-cited: '7'
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title: 'Why is women''s utilization of a publicly funded health insurance low?: a
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qualitative study in Tamil Nadu, India'
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type: Article
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unique-id: WOS:000619749900006
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usage-count-last-180-days: '2'
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usage-count-since-2013: '6'
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volume: '21'
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web-of-science-categories: Public, Environmental \& Occupational Health
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year: '2021'
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